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Related Concept Videos

Aneurysm III: Interprofessional Care01:26

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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Dissecting aneurysm in poor-grade subarachnoid hemorrhage.

Emilio Lozupone1, Francesco Signorelli2, Giovanni Barchetti1

  • 11Department of Neuroradiology, Vito-Fazzi Hospital, Lecce.

Journal of Neurosurgery
|November 7, 2025
PubMed
Summary

Intracranial dissecting aneurysms (DAs) in poor-grade subarachnoid hemorrhage (pSAH) patients have high rebleeding rates. Ultra-early treatment may improve outcomes for these challenging neurovascular lesions.

Keywords:
cerebral aneurysmdissecting aneurysmendovascular neurosurgeryinterventional neurosurgerypoor-grade subarachnoid hemorrhagerebleedingvascular disorders

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Area of Science:

  • Neurosurgery
  • Interventional Neurology
  • Vascular Neurology

Background:

  • Intracranial dissecting aneurysms (DAs) are rare and difficult to treat neurovascular lesions.
  • Patients with poor-grade subarachnoid hemorrhage (pSAH) often experience poor clinical outcomes.
  • Optimal treatment strategies and timing for DAs in pSAH remain unclear.

Purpose of the Study:

  • To analyze clinical features and treatment outcomes of DAs in a national pSAH registry.
  • To identify independent predictors of outcome in pSAH patients with DAs.
  • To evaluate the impact of rebleeding on mortality and long-term disability.

Main Methods:

  • Retrospective analysis of prospectively collected data from the POGASH registry (Jan 2015-June 2024).
  • Included consecutive patients with poor-grade (WFNS grade IV-V) subarachnoid hemorrhage.
  • Classified DAs using the Mizutani classification; assessed outcomes via modified Rankin Scale.

Main Results:

  • Analyzed 60 DA patients from 693 pSAH cases; 54 received treatment (88.9% endovascular).
  • Rebleeding occurred in 23.3% of DA patients, significantly higher than the overall cohort.
  • Rebleeding independently predicted in-hospital mortality (aOR 7.4) and long-term disability (aOR 0.08); blister aneurysms predicted rebleeding (aOR 8).

Conclusions:

  • DAs in pSAH present unique features and a high risk of ultra-early rebleeding.
  • Ultra-early rebleeding significantly impacts clinical outcomes in this patient group.
  • Immediate treatment for DAs in pSAH may offer potential benefits, requiring further study.